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- Infection reaches epididymis via the vas from a primary infection of the urethra, prostate or seminal vesicles
- Younger men: STI - commonly chlamydia or gonococcal
- Older men: UTI or IDC-related
- Blood-borne may be possible - how else would it happen in post-vasectomy men?
- Infection usually starts in the tail then spreads to the rest, and occasionally the testis
- Tuberculous - usually affects lower pole first
- Typically firm, uncomfortable discrete swelling of lower pole of epididymis
- Progression to entire epididymis feeling firm and craggy with normal testis
- Lax secondary hydrocoele in 30%
- Characteristic beading of vas - subepithelial tubercles
- Variable
- Check for symptoms of UTI/STI
- Scrotal wall, at first oedematous and shiny, may become adherent to the epididymis
- Urine MCS
- STI screen
- Scrotal ultrasound
- Consider checking urine and semen for tubercle bacilli in all patients with chronic disease
- Antibiotics - sometimes older men need IV Abx
- Scrotal support
- If abscess occurs, drainage may be necessary
- Consider contact tracing
- Abscess
- Testicular infarction
- Testicular atrophy
- Chronic induration and inflammation
- Infertility
- Chronic non-tuberculous epididymitis
- Usually follows the failure of resolution of an acute episode of epididymitis
- Extended antibiotics and anti-inflammatories (4-6 weeks)
- Epididymectomy or orchidectomy can be considered if no resolution, but may not always resolve pain
